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Clearinghouse consent form

Clearinghouse consent form pdf 2026

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The document is a consent form allowing an employer to conduct a limited query of the FMCSA Drug and Alcohol Clearinghouse to check for any drug or alcohol violations related to the employee. It states that if violations are found, further consent is required to disclose that information. The employee understands that refusal to consent will result in prohibition from safety-sensitive functions.

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Click ‘Get Form’ to open the clearinghouse consent form in the editor.
In the first blank field, enter your full name to identify yourself as the consenting individual.
Next, fill in the name of the company that will be conducting the limited query in the designated space.
Review the consent statement carefully to ensure you understand its implications regarding drug and alcohol violation information.
Sign your name in the provided signature line to formally give consent for the limited query.
Finally, enter today’s date in the specified area to complete your submission of this consent form.

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2019	4.6 Satisfied (56 Votes)

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What needs to be reported to the Clearinghouse?

Only results of DOT drug or alcohol tests or refusals may be reported to the Clearinghouse. While employers may conduct drug and alcohol testing that is outside the scope of the DOT testing requirements, positive test results or refusals for non-DOT testing may not be reported to the Clearinghouse.

How to do a Clearinghouse query?

Click Log In and access the Clearinghouse using your login.gov username and password. Under My Dashboard, go to Queries and click Conduct a Query. Enter the information of the driver you need to query and click Verify Driver Information. Once a drivers CDL information is verified, you will not be able to edit it.

What is the purpose of a Clearinghouse?

The Clearinghouse is a secure online database that gives employers, the Federal Motor Carrier Safety Administration (FMCSA), State Driver Licensing Agencies (SDLAs), and State law enforcement personnel real-time information about commercial drivers license (CDL) and commercial learners permit (CLP) holders drug and

What is a Clearinghouse consent form?

A consent request is how an employer asks for a CDL drivers permission to view his or her information in the Drug and Alcohol Clearinghouse. This would include access to information regarding any drug and alcohol program violations in your record.

What are Clearinghouse rules?

The First Clearinghouse Rule Employers are required to query the Clearinghouse for current and prospective employees drug and alcohol violations before permitting those employees to operate a CMV on public roads. Employers are required to annually query the Clearinghouse for each driver they currently employ.

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What are Clearinghouse requirements?

Clearinghouse Requirements As an employer subject to DOT requirements you have five main obligations regarding the FMCSA Clearinghouse: Queries of new drivers. Annual queries of all existing drivers. Reporting alcohol test positives, employer determined refusals to test and actual knowledge, as defined in Part

Who is required to be in the clearinghouse for FMCSA?

The Clearinghouse rule requires FMCSA-regulated employers, medical review officers (MROs), substance abuse professionals (SAPs), consortia/third party administrators (C/TPAs), and other service agents to report to the Clearinghouse information related to violations of the drug and alcohol regulations in 49 Code of